The exodus of older, experienced doctors has left critical gaps. Younger, less experienced physicians – many of whom are students with no experience in trauma management or emergency medicine – have become indispensable. However, this increases risk for patients and warns of a serious shortage of skilled doctors in future.

In non-government controlled areas, the few health workers left face massive numbers of trauma victims, shortages of medicines, epidemics of infectious disease and chemical attacks. In areas under siege, surgical supplies and essential medicines are seldom allowed in, patients rarely evacuated, and public health measures such as water chlorination and measles vaccination are sometimes blocked.

The bulk of Syria’s remaining health workers are in government-controlled areas, where they also face mortar attacks from rebel areas and travel restrictions. Some report being forced to breach ethical principles under pressure.

Sophie Roborgh, one of the report’s authors from the Department of Politics and International Studies, conducts research on violence against health workers and medical infrastructure in conflict, and how health workers deal with it – professionally and personally.

“Healthcare workers that remain have been forced to adjust their entire lives around the threats and pressures they face,” she says. “There is such a shortage of staff that some physicians and other medical staff actually live full-time in hospitals.

“One medic showed me pictures on his phone of his colleague’s young children, who spend much time with their father, helping to mop up blood in operation rooms. Another told me how he celebrated his wedding in the hospital.

“We are trying to uncover which measures of support for these health workers are actually effective, in the hope that we can eventually move beyond a one-size-fits-all approach to a more specific, evidence-based model for conflict situations.”

Coutts says that practical policy options to assist displaced Syrian healthcare workers require evidence of where they are and what skills and training capacities they have. This information is not currently available and is badly needed.

“It is vital that the international community design policies and interventions to help displaced healthcare workers find and sustain employment in neighboring host countries,” says Coutts.

“Due to visa and right-to-work issues, Syrian doctors and allied health professionals are unable to practice in countries such as Lebanon and Jordan. This is currently an untapped and essential workforce that could be used to support the already overstretched humanitarian response and public services in host communities.”

— Read more in Fouad M. Fouad et al., “Health workers and the weaponization of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria,” The Lancet (14 March 2017) (doi: org/10.1016/S0140-6736(17)30740-7)